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Article Excerpt
Early researchers studying the causes of homelessness often focused on individual pathologies, such as chronic substance abuse or mental illness (Lamb, 1984; Baum & Burnes, 1993), e.g. the risky person model (Aidala, 2006). Others have argued that structural factors, most often conceptualized as socioeconomic changes in the inner-city, are the causes of the increase in homelessness over the past two decades (Harrington, 1984; Blau, 1992). More recent research has argued that both personal and structural factors must be considered. Substance abuse and mental illness do not cause homelessness but make individuals with these disorders more vulnerable to becoming homeless in increasingly competitive housing markets (Burt, 1992; Cohen & Thompson, 1992; Koegel & Burnam, 1992; Shinn, 1992; Koegel, Melamid & Burnam, 1995; Booth, Sullivan, Koegel & Burnam, 2002). Structural factors determine why pervasive homelessness exists in this historical time, while individual factors explain who is least able to compete for scarce affordable housing (Burt, 1992; Cohen & Thompson, 1992; Koegel & Burnam, 1992; Shinn, 1992; Koegel, Melamid, et al., 1995; Booth, Sullivan, et al., 2002).
Drug use as cause or consequence is another frequently argued question. Research has shown that substance use problems afflict anywhere from 28 to 67% of homeless individuals (Fischer & Breakey, 1991; Lehman & Cordrey, 1993; Stahler, Shipley, Bartelt, Wescott, Griffith & Shandler, 1993; Dennis, Bray & Iachan, 1998; Royse, Leukefeld, Logan, Dennis, Weschberg, Hoffman, et al., 2000) and that substance abuse increases individuals' vulnerability to homelessness (Spinner & Leaf, 1992; Winkleby, Rockhill, Jatulis & Fortman, 1992; Johnson, Freels, Parsons & Vangeest, 1997). In contrast, other researchers have argued that drug abuse is more likely to be a consequence of homelessness, as drugs are used to cope with the stresses of homelessness. Johnson and colleagues (1997) found support for both positions and argue that a multidirectional model is more appropriate. In their study, drug use was associated with first homeless episode. Also, prior homeless experiences were found to be predictive of first symptoms of drug abuse. Other research has compared the personal characteristics of drug using with non-drug using homeless (Galaif, Nyamathi & Stein, 1999; Booth, Sullivan, et al., 2002). Homeless individuals with a lifetime or recent diagnosis of substance dependence reported more severe homeless history, more childhood/adolescent vulnerabilities for homelessness, repeated homelessness, indications of poorer quality recent shelter (more days outdoors, fewer nights in places meant for sleeping, more victimization) (Booth, Sullivan, et al., 2002), and less positive social support (Galaif, Nyamathi, et al., 1999).
However, little research has examined the criminalization of drug use and housing policy as potential structural factors that may contribute to the association between substance abuse and homelessness. Many federal policies and laws criminalizing drug use may limit drug users' access to housing, housing subsidies, welfare benefits, and employment. The federal "One Strike and You're Out" law (P.L. 104-120, Sec.9), passed in 1996, allows federal housing authorities to consider drug and alcohol abuse and convictions by people and their family members when making decisions to evict them from or deny them access to federally subsidized housing, although states may opt out of this law. Other policies which have impacted drug users' access to housing include the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, in particular the elimination of the SSI Addiction Disability and a ban on receiving welfare benefits for convicted drug offenders (Anderson, Shannon, Schyb, Goldstein, et al., 2002; Crane, Quirk & van der Straten, 2002; Baumohl, Speiglman, Swartz & Stahl, 2003; Drug Policy Alliance, 2003; Hunt & Baumohl, 2003a; Hunt & Baumohl, 2003b; Norris, Scott, Speiglman & Green, 2003).
Connecticut's prison population has doubled in the last ten years, at a cost of over $513 million per year (Connecticut Department of Correction, 2002). Drug offenders account for a large percentage of this growth (Connecticut General Assembly, 2001), which has had a disproportionate effect on the state's African American population. While African American men comprise less than three percent of Connecticut's population, they account for 47 % of the state's inmates in prisons, jails and halfway houses (Scarponi, 2001). Connecticut has been active in recent years on a range of drug reform efforts, however, including sentencing reform for non-violent drug offenses, an opt-out of the federal welfare ban, data gathering to combat racial profiling, and restoration of voting rights to ex-felons (Drug Policy Alliance, 2003). In addition to these drug reform efforts, Connecticut has funded several supportive housing projects which provide affordable, service enriched rental housing for homeless and at-risk populations, many of whom are coping with mental illness, histories of substance addiction, and/or human immunodeficiency virus/acquired immune deficiency syndrom (HIV/AIDS) (Andersen, University of Pennsylvania Health System, Sherwood, 2002).
Both personal characteristics and structural factors also determine access to more stable housing. Social policies differentially affect various vulnerable populations, which in turn may affect their housing. A number of studies have shown that substance users are significantly less likely to exit homelessness (Zlotnick, Tam & Robertson, 2003) or access social services (Nyamathi, Leake, Keenan & Gelberg, 2000; Nwakeze, Magura, Rosenblum & Joseph, 2003) although the reasons for this have not been systematically studied. In particular, the processes by which a history of arrest impacts access to housing and social services have not been studied. Eligibility requirements or priorities of various local, state and federal housing programs often facilitate access to housing for some (e.g.. women with dependent children, or those with mental illness or HIV diagnoses) while excluding others (e.g. those with criminal records)(Royse, Leukefeld, et al., 2000; Sullivan, Burnam, Koegel & Hollenberg, 2000; Montoya, Atkinson & Struse, 2001; Anderson, Shannon, et al., 2002; Crane, Quirk, et al., 2002).
This article will examine the processes that lead to housing instability among active users of heroin and cocaine using in-depth interviews with housed and homeless drug users. We define housing instability as lack of access to housing, housing loss/evictions, and frequent moves. In particular, we will look at how arrest, previous evictions, lack of welfare benefits or employment, lack of housing subsidies, and disruption of family and social support networks lead to homelessness and housing instability among active drug users. We will also look at structural factors (e.g. the criminalization of drug use, federal housing policies) that create a context of stigmatization that limit drug users' housing and employment options. Finally, we will explore the types of social and financial support provided by institutions or individuals within drug users' personal network that have helped them to access stable housing. Qualitative research is particularly suited to illuminating these processes as drug users describe the events that led to their loss of housing, difficulties in exiting homelessness and strategies used to maintain stable housing.
Methods
The data used in this article were drawn mainly from the Housing Status/Stability and HIV Risk among Drug Users (Housing) study, 2004-2006, a National Institute on Drug Abuse (NIDA) grant which explored the effects of housing policy on drug users' housing status and stability, and the effect of their housing status on HIV risk. These are supplemented with data from the HIV Prevention in High Risk Drug Use Sites: Project RAP (Risk Avoidance Partnership). RAP data used here include observations of monthly Community Advocacy Group meetings of Peer Health Advocates (PHAs), active users of heroin and cocaine trained to conduct harm reduction outreach among their peers, observed as part of the RAP process evaluation. Unless otherwise stated, results come from the Housing project.
In the Housing study, we conducted in-depth interviews with active drug users at baseline, three and six months to explore their housing status and stability over time, the effects of housing policies on their access to housing, and how their housing status and stability affect their HIV risk and drug use behaviors. Purposive sampling was used to identify and recruit drug users in various housing situations. Purposive sampling is used to recruit participants that represent particular variables of interest. The goal is not to generate a representative sample as much as to have sufficient numbers of individuals in each variable of interest in order to discern patterns. In this study, we recruited participants who were in:
1. Supportive housing (subsidized with supportive services)
2. Subsidized housing (rental housing paid for with Section 8 or Shelter Plus Care vouchers)
3. Non-subsidized housing (free market rental housing)
4. Doubling up with family or friends
5. Homeless in shelters
6. Homeless on the street
We defined "doubling up" as the practice of temporarily moving in with family or friends, i.e. those who lived with family, friends or sex partners but who considered the arrangement to be temporary and had lived there for less than three months. Supportive housing was defined as subsidized housing with supportive services attached, such as job training, mental health or substance abuse treatment.
We targeted recruitment in locations where populations of drug users with differing housing characteristics could be found. Drug users who were homeless on the street or in shelters were recruited from each of Hartford's shelters and soup kitchens. Drug users who were doubled up with family or friends, or housed in subsidized, non-subsidized, or supportive housing were recruited through street outreach, or from prior knowledge of their housing status from their participation in the RAP project. Thirty-six (55%) of the Housing participants had participated in the RAP study. We attempted to recruit equal numbers of drug users from each of the housing statuses (approximately 10-11). In spite of these efforts, it proved easier to recruit participants who were doubled up with family or friends than from other housing statuses, with the exception of homeless drug users residing in shelters. Not surprisingly, supportive housing proved to be the most difficult category from which to recruit participants given the limited number of supportive housing programs currently available. We were able to recruit supportive housing participants by directly recruiting RAP participants whom we knew from prior research contact had succeeded in obtaining supportive housing. Interviews were approximately 1 1/2 hours in duration. Participants were paid $25 for completing each interview, with a $15 bonus for completing all three interviews. Written informed consent was obtained from all participants in both the RAP and Housing projects prior to baseline interviews. The research was approved by the Institute for Community Research's Institutional Review Board. Table 1 indicates the percentage of study participants in each housing situation at baseline. Sixty-five drug users were interviewed at baseline. Fifty were located for follow-up interviews at three months. Of those who were not located, four were confirmed to be in jail, and one was confirmed to have moved out of state. Excluding those individuals who were in jail or had moved results in an overall retention rate of 83%. Forty-one were located for interviews at six months. Of those who were not located at six months, two were deceased, two were confirmed to have moved out of state, and five were in jail. Excluding those who had died, gone to jail, or moved out of state resulted in an overall retention rate of 73.2%.
Baseline interviews explored participants' housing histories over the previous two years focusing on: reasons for moves; evictions or housing changes; types of public assistance, social services and housing subsidies applied for and received; the amount of time elapsed between application for and receipt or denial of housing or other social services; and reasons given for denial. To help participants construct their housing histories, we asked participants to describe their current living situations and then moved back in time. To explore perceived housing stability, we asked drug users about what makes them feel stable and secure in...
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